Venous drainage of gonads

Left ovary/testes - left gonadal vein - left renal vein - IVC

Right ovary/testes - right gonadal vein - IVC

Left takes Longest way. Bc the left spermatic vein enters the left renal vein at a 90 degree angle, flow is less laminar on left than on the right. This leads to left venous pressure being higher than right venous pressure. Also, varicocele is more common on the LEFT.

Increased temperature (progesterone induced)

Pregnancy

Fertilization most commonly occurs in upper end of fallopian tube (the ampulla). Occurs within 1 day of ovulation.

Implantation within the wall of the uterus occurs 6 days after fertilization. Syncytiotrophoblasts secrete hCG, which is detectable in blood 1 week after conception and on home test in urine 2 weeks after conception.

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Lactation

After labor, the decrease in progesterone and estrogen disinhibits lactation. Suckling is required to maintain milk production, since increased nerve stimulation leads to higher oxytocin and prolactin.

Low Test, high LH = primary hypogonadism

Other disorders of sex development

1) Female pseudo-hermaphrodite (XX) - Ovaries present, but external genitalia are virilized or ambiguous. Due to excessive and inappropriate exposure to androgenic steroids during early gestation (e.g. congenital adrenal hyperplasia or exogenous administration of androgens during pregnancy)

2) Male pseudo-hermaphrodite (XY) - Testes present, but external genitalia are female or ambiguous. Most common form is androgen insensitivity syndrome (testicular feminization)

Small tumor that grows in lactiferous ducts. Typically beneath areola

Phyllodes tumor

Benign breast tumor

Most common in 5th decade

Some may become malignant

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Proliferative Breast Disease

Most common cause of "breast lumps" from age 25 to menopause. Presents with premenstrual breast pain and multiple lesions, often bilateral. Fluctuation in size of mass. Usually does not indicate increased risk of carcinoma. Histologic types:

Prematurity increases risk of cryptorchidism.

Lower inhibin, high FSH, High LH

Testosterone is normal in unilateral, but reduced in bilateral.

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Varicocele

Dilated veins in pampiniform plexus due to increased venous pressure; most common cause of scrotal enlargement in adult males; most often on left side because of increased resistance to flow from left gonadal vein drainage into left renal vein

Can cause infertility bc of increased temperature

"Bag of worms" on palpation; diagnose by US with Doppler; does not transilluminate

Tx = varicocelectomy, embolization by interventional radiologist

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Extragonadal germ cell tumors

Arise in midline locations. In adults, most commonly in retroperitoneum, mediastinum, pineal, and suprasellar regions In infants and young children, sacrococcygeal teratomas are most common

5% of all testicular tumors. Mostly benign

2) Sertoli cell - Androblastoma from sex cord stroma

3) Testicular lymphoma - Most common testicular cancer in older men. Not a primary cancer; arises from metastatic lymphoma to testes. Aggressive

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Benign prostatic hyperplasia

Common in men older than 50. Characterized by smooth, elastic, firm nodular enlargement (hyperplasia not hypertrophy) of periurethral (lateral and middle) lobes, which compress the urethra into a vertical slit. Not premalignant